ObjectiveTo compare the length of hospitalization for moderate and late preterm infants (MLPIs; 320/7-366/7 weeks gestation) born at tertiary care (level III) perinatal centers versus secondary care perinatal centers (level II).MethodsThis was a retrospective cohort study of all MLPIs born at one of four perinatal centers (one tertiary and three secondary) in Calgary, Canada. All preterm infants born before 360/7 were routinely admitted to neonatal intensive care units (NICUs). We excluded infants with major congenital anomalies and those receiving planned palliative care. Multivariable logistic, propensity score-matched, and quantile regression analyses were used to adjust for potential confounding factors.ResultsOf the 1958 infants who met inclusion criteria, 676 (34.5%) infants were born at a tertiary care perinatal center with a level III NICU, and 1284 (65.5%) were born in secondary care perinatal centers with a level II NICU. The average gestational age was 34.8 weeks. Infants born at level II centers had shorter durations of hospital stay (adjusted mean difference [aMD] -1.0 day; 95% CI -1.7, -0.4) and tube feeding (aMD -2.2 day; 95% CI -2.9, -1.4), a lower need for peripheral intravenous access (adjusted odds ratio (aOR) 0.66; 95% CI 0.53, 0.83), reduced use of infant formula during hospitalization (aOR 0.58; 95% CI 0.43, 0.78), and a higher rate of breastmilk feeding at discharge (aOR 1.34; 95% CI 1.01, 1.77).ConclusionDelivery of MLPIs in secondary care perinatal centers is associated with shorter hospital stays and higher breastmilk feeding rates at discharge.

OBJECTIVE To compare the length of hospital stay for moderate and late preterm infants (MLPIs) born at tertiary care (level III) perinatal centers versus secondary care perinatal centers (level II). METHODS This was a retrospective cohort study of MLPIs admitted to neonatal intensive care units (NICUs) in Calgary, Canada, between January 2016 and December 2017. We excluded infants with major congenital anomalies and planned palliative care. Multivariable logistic and quantile regression analyses were used to adjust for potential confounding factors. RESULTS Of 1958 infants who met inclusion criteria, 676 (34.5%) infants were born at a tertiary care perinatal center with a level III NICU, and 1284 (65.5%) were born in secondary care perinatal centers with a level II NICU. Infants born at level II centers had shorter durations of hospital stay (adjusted MD -1.0 day, 95% CI -1.7 to -0.4 and adjusted HR 1.15, 95% CI 1.04 to 1.28) and tube feeding (adjusted MD -2.2 day; 95% CI -2.9 to -1.4), and a higher rate of breastmilk feeding at discharge (aOR 1.34; 95%CI 1.01 to 1.77). CONCLUSION Delivery of MLPIs in facilities with secondary care perinatal centers is associated with shorter hospital stays and higher breastmilk feeding rates at discharge.

Neonatal hypoxic-ischemic encephalopathy is a clinical phenomenon that often results from perinatal asphyxia. To mitigate secondary neurologic injury, prompt initial assessment and diagnosis is needed to identify patients eligible for therapeutic hypothermia. However, occasionally neonates present with a clinical picture of hypoxic-ischemic encephalopathy without significant risk factors for perinatal asphyxia. We hypothesized that in patients with genetic abnormalities, the clinical manifestation of those abnormalities may overlap with hypoxic-ischemic encephalopathy criteria, potentially contributing to a causal misattribution. We reviewed 210 charts of infants meeting local protocol criteria for moderate to severe hypoxic-ischemic encephalopathy in neonatal intensive care units in Calgary, Alberta. All patients that met criteria for therapeutic hypothermia were eligible for the study. Data were collected surrounding pregnancy and birth histories, as well as any available genetic or metabolic testing including microarray, gene panels, whole-exome sequencing, and newborn metabolic screens. Twenty-eight patients had genetic testing such as microarray, whole-exome sequencing, or a gene panel, because of clinical suspicion. Ten of 28 patients had genetic mutations, including CDKL5, pyruvate dehydrogenase, CFTR, CYP21A2, ISY1, KIF1A, KCNQ2, SCN9A, MTFMT, and NPHP1. All patients lacked significant risk factors to support a moderate to severe hypoxic-ischemic encephalopathy diagnosis. Treatment was changed in 2 patients because of confirmed genetic etiology. This study demonstrates the importance of identifying genetic comorbidities as potential contributors to a hypoxic-ischemic encephalopathy phenotype in neonates. Early identification of clinical factors that support an alternate diagnosis should be considered when the patient's clinical picture is not typical of hypoxic-ischemic encephalopathy and could aid in both treatment decisions and outcome prognostication.

Objective To determine the association of maternal pre-pregnancy body mass index (BMI) and neurodevelopmental impairment (NDI) at 18–24 months corrected age (CA) in infants born < 29 weeks gestation. Study design Infants born between 2005 and 2015 at < 29 weeks gestation were included. BMI was categorized into BMI 1 [18.5–24.9 kg/m 2 ], BMI 2 [25–29.9 kg/m 2 ], BMI 3 [ ≥ 30 kg/m 2 ]. Primary outcome was death or NDI (Bayley-III scores < 85, cerebral palsy, hearing or visual impairment). Univariate and multivariate analysis were used. Results There were 315 infants in BMI 1 , 235 in BMI 2, and 147 in BMI 3 groups. Adjusted odds ratio (aOR) of death or NDI in BMI 2 vs. BMI 1 and BMI 3 vs BMI 1 groups were 1.33 (95% CI 0.86–2.06) and 0.76 (95% CI 0.47–1.22). Adjusted odds ratio of Bayley-III language composite < 85 was 2.06 (95% CI 1.28–3.32). Conclusion Pre-pregnancy BMI was not associated with death or NDI in extremely preterm infants. Infants born to overweight mothers had higher odds of low language scores.

Abstract Background Trainees aiming to specialize in Neonatal Perinatal Medicine (NPM), must be competent in a wide range of procedural skills as per the Royal College of Canada. While common neonatal procedures are frequent in daily clinical practice with opportunity to acquire competence, there are substantial gaps in the acquisition of advanced neonatal procedural skills. With the advent of competency by design into NPM training, simulation offers a unique opportunity to acquire, practice and teach potentially life-saving procedural skills. Little is known on the effect of simulation training on different areas of competence, and on skill decay. Methods We designed a unique simulation-based 4-h workshop covering 6 advanced procedures chosen because of their rarity yet life-saving effect: chest tube insertion, defibrillation, exchange transfusion, intra-osseus (IO) access, ultrasound-guided paracentesis and pericardiocentesis. Direct observation of procedural skills (DOPS), self-perceived competence, comfort level and cognitive knowledge were measured before (1), directly after (2), for the same participants after 9–12 months (skill decay, 3), and directly after a second workshop (4) in a group of NPM and senior general pediatric volunteers. Results The DOPS for all six procedures combined for 23 participants increased from 3.83 to 4.59. Steepest DOPS increase pre versus post first workshop were seen for Defibrillation and chest tube insertion. Skill decay was evident for all procedures with largest decrease for Exchange Transfusion, followed by Pericardiocentesis, Defibrillation and Chest Tube. Self-perceived competence, comfort and cognitive knowledge increased for all six procedures over the four time points. Exchange Transfusion stood out without DOPS increase, largest skill decay and minimal impact on self-assessed competence and comfort. All skills were judged as better by the preceptor, compared to self-assessments. Conclusions The simulation-based intervention advanced procedural skills day increased preceptor-assessed directly observed procedural skills for all skills examined, except exchange transfusion. Skill decay affected these skills after 9–12 months. Chest tube insertions and Defibrillations may benefit from reminder sessions, Pericardiocentesis may suffice by teaching once. Trainees’ observed skills were better than their own assessment. The effect of a booster session was less than the first intervention, but the final scores were higher than pre-intervention. Trial Registration Not applicable, not a health care intervention.

Background: Limited training in targeted neurological examination makes it challenging for frontline pro-viders to identify newborns with perinatal asphyxia eligible for therapeutic hypothermia. This training is important in the era of telemedicine, where the experts can remotely guide further care of these newborns. Methods: This randomized controlled pilot study was conducted in a South Indian tertiary hospital. Neonatal nurses, who had no previous hands-on experience in MSEE, were trained in modified Sarnat staging by a didactic teaching session using online teaching module. The nurses were then randomized into two groups for hands-on demonstration by the same trainer (low -fidelity mannequin versus a healthy term newly born infant). After the training period, MSEEs of a normal newborn were performed independently by nurses and were video recorded and assessed by three blinded neonatologists with expertise in neonatal neurology. A follow-up examination was performed by the same nurses after three months to assess skill retention. Results: The 10 global ratings of the components of the MSEE were comparable among both groups in both initial and follow-up assessments. The overall diagnostic value was comparable between the simulation and traditional groups (93.75%, 94.11%, respectively). Follow-up examination after three months showed better skill retention in the simulation group (84%) compared with the traditional group (66.7%). Conclusions: Online-based and low -fidelity mannequin training was equally effective as the traditional method of teaching MSEE in term neonates.(c) 2022 Elsevier Inc. All rights reserved.

Objective This study aimed to determine neurodevelopmental outcomes of preterm infants born at <29 weeks' gestational age (GA) with bronchopulmonary dysplasia and pulmonary hypertension (BPD–PH) at 18 to 24 months' corrected age (CA). Study Design In this retrospective cohort study, preterm infants born at <29 weeks' GA between January 2016 and December 2019, admitted to level 3 neonatal intensive care units, who developed BPD and were evaluated at 18 to 24 months' CA in the neonatal follow-up clinics were included. We compared demographic characteristics and neurodevelopmental outcomes between the two groups: Group I: BPD with PH and Group II: BPD with no PH, using univariate and multivariate regression models. The primary outcome was a composite of death or neurodevelopmental impairment (NDI). NDI was defined as any Bayley-III score < 85 on one or more of the cognitive, motor, or language composite scores. Results Of 366 eligible infants, 116 (Group I [BPD–PH] =7, Group II [BPD with no PH] = 109) were lost to follow-up. Of the remaining 250 infants, 51 in Group I and 199 in Group II were followed at 18 to 24 months' CA. Group I and Group II had median (interquartile range [IQR]) birthweights of 705 (325) and 815 g (317; p = 0.003) and median GAs (IQR) were 25 (2) and 26 weeks (2; p = 0.015) respectively. Infants in the BPD–PH group (Group I) were more likely to have mortality or NDI (adjusted odds ratio: 3.82; bootstrap 95% confidence interval; 1.44–40.87). Conclusion BPD–PH in infants born at <29 weeks' GA is associated with increased odds of the composite outcome of death or NDI at 18 to 24 months' CA. Key Points

Objective To study the impact of an evidence-based neuroprotection care (NPC) bundle on long-term neurodevelopmental impairment (NDI) in infants born extremely premature. Study design An NPC bundle targeting predefined risk factors for acute brain injury in extremely preterm infants was implemented. We compared the incidence of composite outcome of death or severe neurodevelopmental impairment (sNDI) at 21 months adjusted age pre and post bundle implementation. Results Adjusting for confounding factors, NPC bundle implementation associated with a significant reduction in death or sNDI (aOR, 0.34; 95% CI 0.17–0.68; P = 0.002), mortality (aOR, 0.31; 95% CI (0.12–0.79); P = 0.015), sNDI (aOR, 0.37; 95% CI: 0.12–0.94; P = 0.039), any motor, language, or cognitive composite score <70 (aOR, 0.48; 95% CI: 0.26–0.90; P = 0.021). Conclusion Implementation of NPC bundle targeting predefined risk factors is associated with a reduction in mortality or sNDI in extremely preterm infants.

Objective: To determine the association between the degree of intrauterine growth restriction (IUGR) [defined by birth weight (BW) Z-score] and the efficacy of pharmacologic patent ductus arteriosus (PDA) closure and the rate of surgical PDA ligation in preterm neonates. Materials and methods:In this retrospective cohort study, we included neonates born below 30 weeks' gestational age (GA), who received medical treatment for PDA between January 2010 and December 2018.Birth weight Z-scores were calculated using Olsen nomograms and classified into three categories: above -0.5;from -0.5 to -2.0; below-2.We compared responses to PDA treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and PDA ligations between these groups utilizing multivariable logistic regression analysis.Results: Of 769 neonates with PDA, 517 (67.2%) neonates received medical treatment for PDA.Of which, 323 (62.5%) had BW Z-score above -0.5, 154 (29.8%) had from -0.5 to -2.0., and 40 (7.7%) had below -2.The efficacy of the first course of NSAIDs for the PDA closure was not different among the three groups (51% vs 49% vs 50%).Multivariable logistic regression analysis showed there was no significant difference in PDA closure rate following the first course of NSAIDs between neonates with BW Z-score below -2 and those with BW Z-score above -0.5 [adjusted odds ratio (aOR): 0.68; 95% CI: 0.33-1.39]as well as those with BW Z-score from -0.5 to -2.0 (aOR: 0.89; 95% CI: 0.59-1.35).However, the odds of PDA ligation were significantly higher among neonates with BW Z-scores below -2 (aOR: 2.67, 95% CI: 1.12-6.34)but not among neonates with Z-scores from -0.5 to -2.0 (aOR: 1.41; 95% CI: 0.84-2.39),as compared to those with BW Z-scores above -0.5. Conclusion:We observed a similar rate of PDA closure following the first course of NSAIDs between appropriately grown and growth-restricted neonates.However, severe growth restriction (BW Z-score below -2) is associated with higher rates of PDA ligation as compared to normally grown infants.

Objective To evaluate impact of a quality improvement (QI) outreach education on incidence of acute brain injury in transported premature neonates. Study design Neonates born at <33 weeks gestation outside the tertiary center were included. The QI intervention was a combination of neuroprotection care bundle, in-person visits, and communication system improvement. Descriptive and regression (adjusting for Gestational Age, Birth Weight, Gender, and antenatal steroids, Mode of delivery, Apgars at 5 minutes, Prophylactic indomethacin, PDA, and Inotropes use) analyses were performed. The primary outcome was a composite of death and/or severe brain injury on cranial ultrasound using a validated classification. Results 181 neonates studied (93 before and 88 after). The rate and adjusted odds of death and/or severe brain injury reduced significantly post intervention (30% vs 15%) and (AOR 0.36, 95%CI, 0.15–0.85, P = 0.02) respectively. Conclusion Implementation of outreach education targeting neuroprotection can reduce acute brain injury in transported premature neonates.

Abstract Background More than 1 in 4 preterm infants with bronchopulmonary dysplasia (BPD) develop BPD-associated pulmonary hypertension (BPD-PH) that is associated with significant morbidity. Data regarding neurodevelopmental outcomes with BPD-PH in preterm infants are lacking. Objectives To determine neurodevelopmental outcomes of preterm infants born < 29 weeks gestational age (GA) with BPD associated pulmonary hypertension at 18 to 24 months corrected gestational age (CGA). Design/Methods In this retrospective cohort study, preterm infants born < 29 weeks GA between January 2016 and December 2019 at level 3 Neonatal Intensive Care Units at Foothills Hospital in Calgary and the University of Texas Medical Branch (UTMB) in Galveston, who were evaluated at 18-24 months CGA in the neonatal follow-up clinics were included. We compared demographic factors, neurodevelopmental status including Bayley-III scores and sensory impairments between the two groups based on the presence of PH at 36 weeks CGA: Group I: BPD with PH and Group II: BPD without PH, using univariate and multivariable regression models. The primary outcome was a composite of death or neurodevelopmental impairments (NDI). NDI was defined as any cerebral palsy (GMFCS≥1), Bayley-III score < 85 on one or more of the cognitive, motor, or language composite scores, sensorineural or mixed hearing impairment or unilateral or bilateral visual impairment. Results Of 372 eligible infants, 118 (Group I [BPD-PH] =7, Group II [BPD with no PH] =111) were lost to follow up. Of the remaining 254 infants, 52 in Group I and 202 in Group II were followed at 18-24 months CGA. Group I and Group II had median (IQR) birth weight of 710g (323) and 815g (314) [p=0.004] and median gestational ages (IQR) were 25 weeks (2) and 26 weeks (2) [p=0.020], respectively . Rates of associated impairments are shown in Figure 1. Infants in BPD-PH group (Group I) were more likely to have mortality or NDI (adjusted Odds Ratio [aOR] 3.82; 95% CI: 1.17-12.41) (Table 1). Conclusion BPD-PH in preterm infants born < 29 weeks GA is associated with increased odds of the composite outcome of death or neurodevelopmental impairment and language delay at 18-24 months CGA.

Abstract Background Consensus on definition and management of hypotension in preterm neonates is lacking. Owing to this, there are wide variations in the reported incidence of hypotension in premature infants, especially during first week of life. Inotropes can often cause vasoconstriction, which may alter brain perfusion especially in the absence of established cerebral autoregulation. Use of these drugs is associated with multiple short- and long-term morbidities. Objectives To evaluate the effect of quality improvement (QI) bundle on rate of inotrope use and associated morbidities. Design/Methods Inborn preterm neonates born at <29weeks gestational age (GA) and admitted to level III NICU were included. Neonates with major congenital malformations, congenital heart diseases, antenatal diagnosed genetic defects, and neonates admitted after 72 hours of age were excluded from the study. We implemented a QI bundle (Figure 1) focussing on first 72hours from birth which included delayed cord clamping, avoidance of routine echocardiography, addition of clinical criteria to define hypotension, factoring iatrogenic causes of hypotension (ruling out lung hyperinflation), and standardization of respiratory management. Rate of use of inotropes in the first 72hours of life along with acute brain injury and mortality before and after implementation of the QI bundle were compared. The balancing measure was the rate of ischemic lesions in the form of cPVL. Cranial ultrasound was performed to screen for brain injury. Study was approved by the local research ethics board (REB14-1466). Results We included 671 neonates (301 before and 364 after the implementation of the bundle) among which 6 neonates were excluded based on the criteria. QI bundle implementation was associated with significant reduction in overall use of inotropes (24% vs 7%, p<0.001), dopamine (18% vs 5%, p<0.001), and dobutamine (17% vs 4%, p<0.001). Rate of acute brain injury decreased significantly: Acute brain injury of any grade (34% vs 20%, p<0.001) and severe brain injury (15% vs 6%, p<0.001). There was no difference in incidence of cPVL (1% vs 1.4%, p=0.66). Associations remained significant after adjusting for confounding factors. The QI bundle implementation was associated with a significant reduction in the use of inotropes when analyzed based on the 6 monthly time intervals (p = 0.006) (Figure 2) Conclusion Our QI bundled approach resulted in reduction in inotrope use and associated brain morbidities in premature babies. Follow-up studies evaluating the impact of this initiative on long-term outcomes in survivors are required to complement findings of improved short-term outcomes seen in this study.

Background We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities. Methods We included inborn preterm neonates born at < 29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure. Results QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p < 0.001), dopamine (18 vs 5%, p < 0.001), and dobutamine (17 vs 4%, p < 0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p < 0.001) and severe brain injury (15 vs 6%, p < 0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p = 0.66). Associations remained significant after adjusting for confounding factors. Conclusions A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.

Abstract Background Increasing rates of obesity are of growing concern to maternal and child health as mothers with obesity are at risk of pregnancy complications. Infants of mothers with overweight/obese pre-pregnancy body mass index (BMI) may also be at risk of significant neurodevelopmental disorders. The relationship between maternal pre-pregnancy BMI and neurodevelopmental outcomes in preterm infants is not yet clearly defined. Objectives To determine the association of pre-pregnancy BMI of mothers of infants born <29 weeks gestational age (GA) and neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA). Design/Methods Preterm infants born <29 weeks GA between January 2005 and December 2015 evaluated in the neonatal follow-up clinic at 18-24 months CA were included. Demographic characteristics as well as neurodevelopmental status including Bayley-III cognitive, language, and motor scores and sensory impairments were compared between three groups based on maternal pre-pregnancy BMI (BMI1 [18.5-24.9 kg/m2] vs. BMI2 [25-29.9 kg/m2] vs. BMI3 [≥30 kg/m2]) using univariate and multivariable regression models. The primary outcome was a composite of death or NDI. NDI was defined as the presence of Bayley-III <85 on one or more of the cognitive, motor, or language composite scores, any cerebral palsy (GMFCS ≥1), sensorineural or mixed hearing impairment, or unilateral or bilateral visual impairment. Results Of 771 eligible infants, 53 not seen in the follow-up clinic and 21 born to mothers with BMI <18.5 kg/m2 were excluded. Of the remaining 697 participants, 315 (45%) infants were in BMI1, 235 (34%) in BMI2, and 147 (21%) in BMI3 groups. Infants in BMI1, BMI2, and BMI3 groups had mean (SD) birth weight of 897 (231), 854 (208), and 867 (234) grams and median GA (IQR) of 27 (3), 26 (2), and 27 (3) weeks respectively. Rates of associated impairments are shown in Figure 1. The odds of a composite of death or NDI in BMI2 vs. BMI1 and BMI3 vs BMI1 groups were 1.33 (95%CI 0.86-2.06) and 0.76 (95%CI 0.47-1.22) respectively (Table 1). Infants born to mothers in the BMI2 group had twice the odds of scoring <85 on the Bayley-III language composite than those in BMI1 (adjusted odds ratio 2.06 [95% CI; 1.28-3.32]). Conclusion Pre-pregnancy body mass index was not associated with death or neurodevelopmental impairment in very preterm infants at 18-24 months corrected age. However, infants born to mothers who were overweight were more likely to have lower language scores.

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Pulmonary Hypertension (PH) is estimated to occur in 1 in 4 infants with Bronchopulmonary Dysplasia (BPD). The impact of PH in infants with BPD on their neurodevelopmental (ND) outcomes is uncertain. Objectives This systematic review aims to evaluate whether PH in infants with BPD is associated with ND delay. Design/Methods A systematic literature search was performed to identify studies that reported ND outcomes of infants with BPD (based on NIH definition) and PH (based on echocardiographic findings of PH at 36 weeks PMA). The primary outcome was ND delay in infants with pulmonary hypertension associated with BPD compared with BPD alone. Standardized developmental tests evaluated ND outcomes at 18-24 months corrected age (CA) and three years of age. Quality assessment of the studies was done using the Newcastle-Ottawa Quality Assessment for Cohort studies. Results Three retrospective cohort studies met the inclusion criteria. Two studies reported ND outcomes based on Bayley Scales of Infant and Toddler Development-III Edition in cognitive, language, and motor domains at 18-24 months CA (Table 1 and Figure 1). One study reported outcomes at 3 years, including overall developmental delay (Kyoto Scale of Psychological Development [KSPD] scores < 70) and cerebral palsy. The quality of all 3 studies was rated between good, fair, and poor. Pooled data from the 2 studies reporting outcomes at 18-24 months showed no difference between the 2 infant groups for Bayley cognitive score < 85 (Odds ratio [OR]: 3.78; 95% CI 0.87-16.52), Bayley language score < 85 (OR: 1.19; 95% CI0.57-2.49), and Bayley motor score < 85 (OR: 2.04; 95% CI 0.89-4.67). At 3 years of age, children in the BPD-PH group had an increased risk of developmental delay (DQ < 70 in all areas) compared with the BPD group (OR: 4.37; 95% CI 1.16-16.46), but no difference in the risk of cerebral palsy (OR: 0.57; 95%0.03-12.39). Conclusion PH in BPD is not associated with a developmental delay compared to BPD alone at 18-24 months CA. However, a single study showed infants in BPD-PH had delayed development at 3 years of age. A large prospective cohort study with longer multidisciplinary follow-up is required to confirm this.

Objective To compare neurodevelopmental outcomes of large and appropriate for gestational age (LGA, AGA) infants <29 weeks’ gestation at 18–24 months of corrected age. Study design Retrospective cohort study using the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases. Primary outcome was a composite of death or significant neurodevelopmental impairment (NDI), defined as severe cerebral palsy, Bayley III cognitive, language and motor scores of <70, need for hearing aids or cochlear implant and bilateral visual impairment. Univariate and multivariable logistic analyses were applied for outcomes. Results The study cohort comprised 170 LGA and 1738 AGA infants. There was no difference in significant NDI or individual components of the Bayley III between LGA and AGA groups. LGA was associated with the increased risk of death by follow-up, 44/170 (25.9%) vs. 320/1738 (18.4%) (aOR: 1.60 95% CI: 1.00–2.54). Conclusions Risk of NDI was similar between LGA and AGA infants.

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants who are also intrauterine growth restricted (IUGR) experience more frequent and earlier hemodynamic consequences of patent ductus arteriosus (PDA). This may be related to altered levels of prostaglandins or altered number or sensitivity of their receptors in IGUR infants. Few studies have examined the efficacy of pharmacologic therapy (non-steroidal anti-inflammatory drugs [NSAIDs]: indomethacin, ibuprofen, or acetaminophen) for PDA closure among preterm infants based on their degree of IUGR with differing results. Objectives Primary: To determine if the degree of IUGR [defined by birth weight (BW) z-score] affects the efficacy of pharmacologic PDA closure and rate of surgical PDA ligation in preterm infants. Secondary: To compare the side effects of NSAIDs and neonatal outcomes based on the severity of IUGR. Design/Methods This retrospective cohort study included infants of < 30 weeks’ GA, admitted to a tertiary neonatal intensive care unit (NICU) between 2010 and 2018, with hemodynamically significant PDA and treated with NSAIDs. Infants with major congenital anomalies, those who received prophylactic Indomethacin and those who died in the first 48 hours were excluded. Birth weight (BW) z-scores were calculated using Olsen nomograms and classified into 3 categories: z-score > −0.5 (normal), z-score −0.5 to −2.0 (mild to moderate growth restriction), z-score <−2 (severe IUGR). We compared responses to NSAID treatment and PDA ligation. Multivariate logistic regression analysis was done to examine the association of BW z-score and response to pharmacological therapy and subsequent surgical PDA ligation. Results Of the 1511 eligible infants, 769 (51%) had a diagnosis of PDA. Of 517 included infants, 323 (62.5%) had BW z-score >− 0.5, while 154 (29.8%) had z-scores − 0.5 to −2.0 and 40 (7.7%) had z-score < −2. Table 1 shows their demographic characteristics. Efficacy of first course of NSAIDs was not different among these birth weight groups (Table 2). There was no difference in the side effects and neonatal morbidities amongst the three groups (Table 2). Multivariate logistic regression analysis after controlling for GA, gender, antenatal steroids, C-section, and SNAP II showed that the odds of PDA ligation was significantly higher among infants with BW z-score < −2 (aOR 2.68, 95% CI 1.13- 6.36) but not among infants with z-score −0.5 to−2.0 (aOR 1.41, 95% CI 0.84, 2.39) as compared to z-score >-0.5. Conclusion Preterm severe IUGR infants with z-score < −2 have an associated increased risk of PDA ligation following pharmacologic treatment as compared to normally grown infants.

Aim: To evaluate the impact of outreach education targeting neuroprotection on outcomes of outborn infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Methods: A retrospective cohort study of infants admitted with moderate-to-severe HIE was conducted following the implementation of outreach education in January 2016. Key interventions were early identification and referral of infants with encephalopathy utilizing telemedicine and a centralized communication system, hands-on simulation, and interactive case discussion and dissemination of clinical management guidelines and educational resources. The association between the intervention and a composite outcome of death and/or severe brain injury on brain magnetic resonance imaging (MRI) was tested controlling for the confounding factors. Results: Of 165 neonates, 37 (22.4%) died and/or had a severe brain injury. This outcome decreased from 35% (27/77) to 11% (10/88) following the implementation of outreach education (P<0.001). Eligible infants not undergoing therapeutic hypothermia within 6 hours from birth decreased from 19.5% (15/77) to 4.5% (4/88). The use of inotropes decreased from 49.3% (38/77) to 19.6% (13/88). Any core temperature below 33 degrees C was recorded for 20/53 (38%) before and 16/78 (21%) after, while those within the target range of 33 degrees C to 34 degrees C at admission to a tertiary care facility increased from (15/53) 28% to (51/88) 58%. Outreach education was independently associated with decreased composite outcome of death and/ or severe brain injury on MRI (adjusted odds ratio 0.2; 95% confidence interval 0.07 to 0.52). Conclusion: Outreach education targeting neuroprotection for infants with moderate-to-severe HIE was associated with a reduction in death and/or severe brain injury.

An amendment to this paper has been published and can be accessed via the original article.